| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | PO BOX 3430 CARMEL, IN 76082 | ANTHEM INSURANCE COMPANIES, INC. | $146K | $0 | $146K | 1.21% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | PO BOX 908 FORT WORTH, TX 76101 | ANTHEM INSURANCE COMPANIES, INC. | $31K | $0 | $31K | 0.26% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | PO BOX 3430 CARMEL, IN 46082 | SUN LIFE ASSURANCE COMPANY OF CANADA | $44K | $0 | $44K | 3.72% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 | 1933 STATE ROUTE 35, STE 368 WALL, NJ 07719 | SUN LIFE ASSURANCE COMPANY OF CANADA | $39K | $0 | $39K | 3.30% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | PO BOX 908 FORT WORTH, TX 76101 | SUN LIFE ASSURANCE COMPANY OF CANADA | $21K | $0 | $21K | 1.73% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 1,362 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,368 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 1,171 | $12.1M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,413 | $1.2M |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,413 | $1.2M |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,413 | $1.2M |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,413 | $1.2M |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,413 | $1.2M |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,413 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,413 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.